View clinical trials related to Colorectal Neoplasms.
Filter by:Complete and timely colonoscopy after an abnormal stool-based colorectal cancer screening test results in early detection, cancer prevention, and reduction in mortality, but follow-up in safety-net health systems occurs in less than 50% at 6 months. The proposal will implement multi-level approach consisting of a stepped-wedge clinic-level intervention of team-based best practices co-developed with primary and specialty care, a patient-level technology intervention to provide enhanced instructions and navigation to complete diagnostic colonoscopy, and a mixed methods evaluation to explore multi-level factors contributing to intervention outcomes. Developing a solution to this high-risk and diverse population has the potential to translate to other health systems, support patient self-management, and address other patient conditions.
Colorectal cancer (CRC) is the 3rd most common cancer worldwide and accounts for ~14,000 new diagnoses and ~5,000 deaths in the Netherlands yearly (1.9 million and 935 thousand on a global level). Large scale transcriptional profiling of primary CRC tumors has revealed the presence of four distinct consensus molecular subtypes (CMSs). The CMS4 subtype is associated with a poor prognosis, especially in early CRC, and may benefit less from several standard systemic treatments (e.g. oxaliplatin, 5-fluorouracil, cetuximab), while being relatively sensitive to irinotecan. This is relevant as in the metastatic setting often the first choice first-line systemic therapy regimen is oxaliplatin and not irinotecan-based. Furthermore, tumor cells can acquire a CMS4 phenotype following exposure to chemotherapy, which may contribute to therapy resistance. CMS4 accounts for ~25% of all early-stage CRC patients and is more prevalent in advanced disease stages (~40% in stage IV CRC). Currently available CMS4 diagnostic tests require tumor tissue samples. The interpretation of biopsy-based CMS4 diagnosis is however complicated by large intra- and inter-lesion heterogeneity of CMS4 status. Extensive biopsy protocols could address the problem of CMS4 heterogeneity but are challenging in routine clinical practice. The development of CMS4-targeted therapy strategies therefore requires a more robust and clinically applicable diagnostic test for comprehensive quantitative assessment of CMS4 status of all lesions - primary and metastatic - in individual cancer patients. A promising solution for such a diagnostic test is to use a radiotracer that enables the quantitative assessment of CMS4 in vivo by whole body molecular imaging. This technique is particularly suited to assess biomarkers with heterogeneous expression: for diagnostic purposes, as a companion diagnostic for (targeted) therapies, or as part of a 'theranostic' strategy where patient selection using the diagnostic radiotracer is followed by treatment with the same tracer labeled to a therapeutic compound. Radiolabeled fibroblast activating protein inhibitor (FAPI) is an emerging diagnostic radiotracer that allows the comprehensive whole-body, whole-tumor assessment of fibroblast activation protein (FAP) expression in humans with a very low background uptake also at frequent CRC metastatic sites including the liver. FAP is an excellent candidate molecular imaging target for CMS4, as it is highly expressed on cancer-associated fibroblasts (CAF) that are abundantly present in this CRC subtype. Indeed, the investigators found that FAP gene-expression measured in tumor biopsies - as a single marker - accurately discriminates CMS4 from other CRC subtypes (area under the receiver operating characteristic curve (AUROC): 0.91; 95% confidence interval (CI): 0.90-0.93). The FoCus study will aim to take a next step by relating in vivo assessed FAP protein-expression by [18F]-ALF-FAPI-74 positron emission tomography (PET) / computed tomography (CT) to CMS4 status in patients eligible for colorectal liver metastatectomy as a first proof of concept. Ultimately this will contribute to the development of a diagnostic tool for the comprehensive assessment of CMS4 load in patients with (metastatic) CRC by using [18F]-ALF-FAPI-74 PET/CT molecular imaging, to guide CMS4 subtype-directed therapy decisions.
In this study, the investigators collected data with the SEER*Stat software version 8.4.1 (accession number: 20377-Nov2021). The patients with confirmed diagnoses of CRC (site code C18.0-20.9 and C26.0) between 2004 and 2013 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Due to the significant disparity in the number of cancer survivors with various prior cancer types among newly diagnosed CRC patients, the investigators utilized the International Classification of Diseases for Oncology, 3rd edition (ICD-O-3) Site Recode to identify 10 common previous cancer sites, including the colorectum, prostate, breast, uterus, bladder, skin, lung, kidney, thyroid, and stomach. CRC patients with a prior history of cancer originated from one of the 10 sites and surgical CRC patients without a prior history of cancer were enrolled in this study. The exclusion criteria were as follows: (1) Patients with more than one cancer in the past; (2) The patient's age at diagnosis was <18 years old; (3) Patients with incomplete survival data and follow-up information; (4) Patients only had autopsy or death certificate records. The primary outcomes of this study were overall survival (OS) and cancer-specific survival (CSS). OS was defined as the time from diagnosis to date of death（patients who were still alive at the end of follow-up were considered as censored data. CSS was defined as the time from diagnosis to date of death caused by CRC (patients who deaths from other causes or still alive at the end of follow-up were considered as censored data). The investigators set December 31, 2018, as the cut-off date for follow-up to ensure that all included cases (diagnosed in 2004-2013) were followed for at least 5 years. Based on prior cancer history, the surgical cases were categorized into two groups: 'Non-prior cancer history' and 'Prior cancer history.' The 'Prior cancer history' group was further subcategorized by the type of prior cancer, including colorectum, prostate, breast, uterus, bladder, skin, lung, kidney, thyroid and stomach. The bias between different Prior cancer history group and Non-prior cancer history group was minimized by Propensity Score Matching (PSM), and the Kaplan-Meier method and log-rank tests were used to compare OS and CSS differences. And then, a multivariate Cox proportional hazards model was performed to estimate the hazard ratios (HR) and 95% confidence interval (CI) to analyze whether different types of prior cancer history impacted the OS and CSS in patients who underwent surgery for spCRC independently. Common demographic and clinicopathological data, including age at diagnosis of spCRC, sex, race, marital status, tumor location of spCRC, pathologic grade of spCRC, TNM stage of spCRC (0-I, II-III, IV and unknown) and chemotherapy status were entered as covariates. Kaplan-Meier curves were also constructed according to the time since first cancer diagnosis (latency), age diagnosed with spCRC, and spCRC stage. Further analysis was performed to determine the impact of surgery on survival of spCRC patients with different type of prior cancer history. The investigators divided patients into surgical and non-surgical groups based on whether surgery was performed, and then assessed the effect of surgery on survival using the propensity score-adjusted Kaplan-Meier method. In this study, the baseline characteristics of patients were compared using Chi-square test and Fisher's exact test. A one-to-one propensity score matching (PSM) was performed to reduce the selection bias of the two groups of baseline variables. When performing one-to-one propensity score matching between the prior cancer history group and the non-prior cancer history group, the investigators chose a caliper of 0.2. However, the investigators opted for different calipers when matching the surgical and non-surgical groups because the investigators believe that patients with different prior cancers were in entirely different situations. A two-sided probability value of P ≤ 0.05 was considered statistically significant. R software (version 4.2.3) was used for all statistical analysis.
Colorectal cancer is a common but preventable condition, and increasing colorectal cancer screening is one of the most impactful public health contributions in the field of gastroenterology. Text messaging is a simple, cheap, and rapid method to reach patients that may improve adherence to colonoscopy appointments as well as simplify the process of bowel preparation. The purpose of the study is to evaluate the feasibility of a pilot bidirectional text messaging intervention on attendance for screening/surveillance colonoscopy and bowel preparation quality at an urban VA hospital. The goal is to improve adherence to colonoscopy among patients who are due for a repeat colonoscopy.
This is a multi-center, single-arm study to investigate the efficacy and safety of liposomal irinotecan+5-FU/LV+ bevacizumab as second-line therapy in metastatic colorectal cancer in Chinese population.
The purpose of this research study is to evaluate the efficacy of a digital navigation tool, called the eNav to improve colorectal cancer screening uptake among patients treated at federally qualified health centers (FQHC)s. The digital navigation tool includes a website and text messaging support. The website includes information, motivational support, decisional support and cues to action (e.g., ability to request a CRC screening test). The eNav tool also includes text-messaging based navigation (e.g., reminders, instructions to complete the screening test).
To study the efficacy and safety of embolization therapy with uniform particle size drug-eluting beads loaded with irinotecan (DEBIRI) in patients with unresectable colorectal cancer liver metastases.
The goal of this clinical trial is to explore the feasibility of a new mode of chemotherapy and bevacizumab induction therapy combined with immunotherapy as first-line treatment for patients with initially unresectable metastatic colorectal cancer (MSS). The main questions it aims to answer are: 1. To explore the efficacy and safety of this treatment mode 2. Try to study treatment benefit the characteristics of the crowd Participants will combined with immunotherapy after chemotherapy and bevacizumab induction therapy.
The objective of this pilot study is to compare the effectiveness of mailed outreach of two stool based tests, Cologuard and the fecal immunochemical test (FIT) in screening eligible adults ages 45-49 receiving care at the University of California San Diego Health system.
Microscopic colitis (MC) is an inflammatory bowel disease characterized by chronic non-bloody watery diarrhoea and a macroscopically normal colonic mucosa upon endoscopic exploration (colonoscopy). The diagnosis is performed by microscopic examination of mucosal biopsies that reveal specific histopathological change. Between 4-20% of patients with chronic non-bloody diarrhoea who undergo colonoscopy with serial biopsies are diagnosed with MC. It has long been hypothesized that the microbiome plays a key role in the pathogenesis of MC. In patients with collagenous colitis, faecal stream diversion results in inflammation and histological remission, followed by disease relapse after intestinal transit is reconstructed. Moreover, studies carried out with faecal samples obtained after colonoscopy have demonstrated microbiome changes (reduced alpha diversity and higher microbial dysbiosis index) in patients with active MC. To avoid potential bias due to the effect of colonic lavage prior to colonoscopy in microbiota composition, the researchers of the present study previously evaluated the microbiome in faecal samples obtained before the diagnostic colonoscopy in patients with active MC. The results confirmed a reduced alpha diversity in diarrhoea groups; however, there were no differences between MC, bile-acid diarrhoea and functional diarrhoea. The microbial dysbiosis index was significantly higher in MC compared to the other diarrheal groups, but no bacterial species showed a significantly different relative abundance. On the other hand, the risk of colorectal cancer (CRC) or adenoma seems to be reduced in MC compared to controls. Growing evidence suggests microbial dysbiosis is a crucial environmental factor in the initiation of precancerous lesions of CRC such as adenomas. The objective of the current multicentric prospective study is to assess the differences in the mucosa adherent intestinal microbiome between patients with MC, non-MC chronic diarrhoea, healthy controls and patients with advanced colon adenomas. In addition to the study of the microbiome, sociodemographic variables, history of drug usage, diets and specific characteristics of diarrhoea will be collected. The hypothesis of the present study is that CM presents a specific mucosa adherent intestinal bacterial profile that may be relevant in the pathogenesis of the disease and that, additionally, may also play a protective role against the development of CRC and adenomas.